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"I found out I had HIV when I was pregnant for the first time, in 2009. In Kyrgyzstan, all women are tested during pregnancy twice, once early on and once later in the pregnancy. They say it is your choice whether to get tested, but if you don't then you cannot get maternity services. The result was a shock but I wanted to have my child.

My medical card has a code on it which shows that I have HIV to anyone who knows the codes... as soon as people in the hospital saw that code, they didn't want to help me

I sat down with my own maternity doctor and with the AIDS Centre and made a plan with them about the delivery and how it would be managed, because there is a lot of stigma associated with HIV in Kyrgyzstan. So, my doctor understood the issues. But when I started to give birth, my doctor was not available. So that meant I had to go to the maternity hospital and be seen by whoever was there. My medical card has a code on it which shows that I have HIV to anyone who knows the codes. There was no question about whether I disclosed my status – it was already there, on my medical card. And as soon as people in the hospital saw that code, they didn't want to help me. They started to find all kinds of reasons for rejecting me, for not being able to help with the delivery, but it was only because they were afraid of my HIV. Even the management of the hospital didn't want to accept me.

When people came to help with the birth, they were dressed up with gloves and suits and masks like spacemen

Eventually, I managed to contact the Head of the AIDS Centre and they intervened with the Head of the hospital to let me stay there, because I was about to give birth. But even then and despite their intervention, I was put in an isolation room. When people came to help with the birth, they were dressed up with gloves and suits and masks like spacemen. They were obviously very reluctant to touch me or even the baby. They left us in isolation the whole time I was there recovering, even when the baby was crying. It was awful. Afterwards I went back to that hospital with people from the AIDS Centre. We did some training with them and I talked about my experience and why it was wrong. It was very successful and it has led to further training sessions in other maternity hospitals, so I hope that some good has come of it. But I know, from later experiences and from other women, that there is still a long way to go to get rid of stigma in our maternity system.

They left us in isolation the whole time I was there recovering, even when the baby was crying. It was awful

"

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Occult hepatitis B in hepatitis C-associated hepatocellular carcinoma

22/04/2019

Occult hepatitis B virus (HBV) infection was detected in 50% of patients with chronic hepatitis C virus (HCV) infection who also have chronic HCV-related hepatocellular carcinoma (HCC), according to data published in the European Journal of Gastroenterology and Hepatology.

To clarify the clinical and pathologic characteristics of occult HBV infection in patients with chronic HCV-related HCC, researchers sampled DNA from serum and tumor tissue. The virus was detected using quantitative polymerase chain reaction, and clinicopathologic features were compared between patients with HCC who also have occult HBV infection and those without occult HBV infection.

Overall, the frequency of occult HBV infection was 50% in patients with HCV-related HCC. The HBV genotype D was found in 35% of those with HCC and was the most dominant genotype in the study. Approximately 80% of patients with occult HBV infection had anti-hepatitis B core (HBc) antibodies, while 20% had no serologic markers. The results also revealed a significant association between tissue HBV-DNA and positive serum HBV-DNA, anti-HBc, and genotype D.

No clinical differences between patients with HCC with and without occult HBV infection were observed except that patients with occult HBV infection tended to be younger. Those with HCC and occult HBV infection demonstrated significant association with positive anti-HBc antibodies and late histologic grade disease. A multivariate logistic regression analysis showed that the presence of occult HBV infection was a predictor of more advanced HCC histologic grades in those with HCV infection.

The study investigators noted that this study is limited by a relatively small sample size and by being conducted at only a single center. Researchers also noted that while some previous studies have reported an association between occult HBV infection and HCC, others have not. However, the study authors adhere to their finding that patients with occult HBV infection have more advanced HCC histologic grades, which “supports the potential involvement of [occult HBV infection] in hepatocarcinogenesis.”

This work revealed that a high frequency of occult HBV infection may be occurring in people with HCV with related HCC and that the presence of occult HBV infection is most reliably predicted by the positive anti-HBc status of a patient. The study did not find any significant effect on clinical consequences in patients with chronic HCV infection with HCC, but the study investigators suggested that status of occult HBV infection in the context of HCC warrants further study using well-designed multicenter studies.

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